New branch of cancer treatment at UCLH 

02/12/2013 00:00 
UCLH is leading the way in offering a new ‘menu of care’ for cancer patients which gives them treatment options that are precisely targeted and do not require complicated surgery.

This branch of cancer treatment, known as ‘interventional oncology’ adds another set of highly effective treatment options to traditional surgery, with the added bonus of quicker recovery and less time in hospital for patients.

As part of the Interventional Oncology Service (IOS), patients whose options were previously surgery, radiotherapy or drugs, benefit from leading-edge treatment. This includes cryotherapy - which uses freezing gas to destroy tumours – or embolisation which uses tiny particles soaked in high-dose chemotherapy to block tumour blood vessels and deliver a very high, targeted dose of chemotherapy directly to the tumour.
The IOS is also able to offer patients the support of a dedicated clinical nurse specialist who has a specialist knowledge of the procedures undertaken and possible complications.
Patients meet the consultant who performs the image guided intervention in a formal clinic setting before and after the treatment. At that time they are able to feed back on the quality of care they have received. To date, the service has received a unanimous seal of approval.
While the procedures themselves are available elsewhere, at UCLH there is a clinical infrastructure to support the work of the interventional radiologists, whereas elsewhere the clinics are run by surgeons and oncologists while the treatment is carried out by the radiologists.
Peter Ellis, 66, is one patient who has benefited from the service. After being diagnosed with cancer of the kidney in the 1998 and having his right kidney removed, he was diagnosed with an indeterminate growth on his left kidney during a routine scan in 2011 and was scheduled for partial removal of the kidney.
“I had serious doubts when I overheard a comment at an assessment, two weeks before the procedure, about my kidney being 'taken away'. I play golf, go fishing and work four days a week. The last thing I wanted was dialysis.”
But when he heard about the interventional oncology service he asked to be referred to UCLH where Rowland Illing recommended cryotherapy.
“He explained cryotherapy as a minimally invasive procedure to kill the cancer using freezing gas, inserted via special needles. I'd lose only 15 per cent of my kidney, not half.”
He added: “I was relieved that the procedure wouldn't involve what I went through when my other kidney was removed. They'd had to break my ribs to reach it, and afterwards I was made to keep coughing, to prevent a lung infection, which was agonising. I had a catheter and drainage bag during my five days in hospital, and full recovery took a month.”
The cryotherapy was done under a general anaesthetic and took two and a half hours.
Mr Ellis left hospital the next day and had a week off work, though I felt I could have gone back sooner.
He said: “There's no guarantee the cancer won't return, but it can never occur in the same place. The frozen area is like a burned-out hulk with all the tissue destroyed, but my kidney function isn't affected. I've been monitored regularly since and am fine so far. I'm delighted with the treatment.”
Dr Illing said: “We gave Peter a general anaesthetic and slotted him into a CT scanning machine, which produces a 3D image of inside the body.
“Next, we inserted hollow metal needles into the kidney tumour. A computer linked to the scanning machine allowed us to guide the needles into the correct position. Inserting the needles, or cryoprobes, is challenging, like a magician's sword trick. They mustn't pierce blood vessels and while they can be inserted when the patient is breathing in or out, the key is to ensure they are inserted in the same rhythm every time. This is because other organs shift position in sync with the lungs.
“Whenever an organ undergoes surgery there's a risk of bleeding. But these risks are lower with cryotherapy because we're not cutting into the organ. The usual risks with operations, such as infection, apply, but are minimal.
“The team's skill lies in getting rid of just enough tissue. It's a trade-off between losing as little as possible and having a margin so that all the cancer cells are killed off.
“We are undertaking research into the next generation of cryoablation systems that will allow us to work inside an MRI machine for even clearer pictures of the treatment being undertaken.”

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